Pacific Coast Society of Orthodontists Bulletin Spring 2020 - 45

Case Report

Figure 6. Progress photos showing the insertion of two miniscrews (VectorTAS, 1.6 mm × 6 mm) between maxillary laterals and canines
immediate improvement of the open bite,
which was maintained during the rest of the
treatment with the help of elastics.
Because the patient had a moderate hyperdivergent growth pattern, we were aware that
one of the challenges of this case would be
to fully close the maxillary second premolar
spaces without excessive retraction of the
maxillary incisors and without decreasing
the overbite and reaching an edge-to-edge
anterior occlusion or even a negative overjet.
In the seventh month of treatment, two
anterior miniscrews (6-mm length, 1.4-mm
diameter; VectorTAS, ORMCO, Glendora, CA)
were installed under topical anesthesia. The
TSADs were positioned between the U2s and
U3s, at about the coronal third of their roots.
To use the TSADs as indirect anchorage, stainless steel ligature ties of 0.010-inch diameter
were braided from the miniscrew to the bracket of the canine on the same side. At this point
in the treatment, the patient had a custom

Spring 2020    PCSO Bulletin	

Damon 0.016 × 0.025-inch stainless steel wire.
Sliding closing mechanics were used with the
help of power chains from U3s to U4s and U6s.
The chains were changed every two to three
weeks to keep them active. The mechanics
were continued until the complete space closure of the U5s. To prevent the anterior open
bite from reopening and to help maintain the
anterior anchorage, vertical seating elastics
were given to the patient (3/16-inch, 2 oz, U3s
to L3s, full time) during most of the space
closure mechanics (Figure 6).
It was also decided that the prominent
marginal ridges on the palatal surfaces of
U2-2 might interfere with the space closure
and also prevent a good anterior coupling,
so they were smoothed down with a highspeed football diamond bur. During space
closure, there was a slight loss of anterior
anchorage that could be visualized from the
space opening mesial to UL3. This space was
easily closed after closure of all the posterior
spaces. Thereafter, the TSADs were removed

to help the consolidation of the contact
points between U2s and U3s. The protraction of the maxillary posterior sectors was
finished in a total of 10 months.
The finishing wires were 0.019 × 0.025 inch
INGSIGNIA TMA in the maxillary arch and
0.017 × 0.025 inch INSIGNIA TMA in the
mandibular arch. The U7s, interestingly
enough, followed the U6s in space closure
mechanics without being engaged because
of the transseptal fibers. These molars were
bonded during the finishing stages. Detailed
wire bending and seating elastics (3/16 inch,
2 oz, U3s to L3s, full time) were used for this
last part of the treatment.
Upon completion of treatment, an upper Essix
retainer and lower bonded bar 3-3 were delivered for retention. The patient was told that
the upper Essix had to be worn full time for 12
months and then only at night. In addition, the
patient was referred to his dentist for dental
care and evaluation of the mandibular third

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Pacific Coast Society of Orthodontists Bulletin Spring 2020

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